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Bransteter I, McVoy M, Miller DW, Gubitosi-Klug RA, Segall TL, Divan MK, Surdam J, Sajatovic M, Dusek JA. Barriers and Facilitators to Incorporating an Integrative Mind-Body Intervention in Youth With Type 2 Diabetes. JAACAP OPEN 2024; 2:208-216. [PMID: 39552817 PMCID: PMC11562543 DOI: 10.1016/j.jaacop.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 11/19/2024]
Abstract
Objective There has been little to no qualitative research done with adolescents and young adults (AYA) with type 2 diabetes (T2D) that can guide creation of interventions for this demographic. Using qualitative research methods, a novel mind-body intervention called Intervention for Early Onset Type 2 Diabetes (INTEND) has been developed for AYA aged 15 to 20 years, with the goal of improving self-management and coping skills, by enhancing routine care with augmented education coupled with mind-body skills. Method Qualitative interviews with AYA 15 to 20 years of age with T2D, their parents, and professionals caring specifically for this population were done through a focus group model. Transcripts were created, depersonalized, and coded using a Consensual Qualitative Research (CQR) method. Identified themes then guided the creation of course materials that included education about self-management of T2D and how to use the 4 mind-body technique toward self-care and regulation. Results The qualitative approach used in the development of this intervention revealed important findings in understanding key barriers faced by this group, key facilitators that improve their quality of life, and core components of an intervention that would be acceptable to them. Conclusion Results of this qualitative study helped craft an intervention tool that can subsequently be deployed and evaluated for effectiveness. Findings of the qualitative research model allow us to better understand the lived experience of AYA living with T2D. Clinical guidance •Stigma of type 2 diabetes in adolescents may interfere with patients' ability to adequately adhere to treatment recommendations•Clinicians need to identify social supports for adolescents with type 2 diabetes•Identifying family members and including them in treatment plans may help adolescents with type 2 diabetes.
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Affiliation(s)
- Irina Bransteter
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Molly McVoy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Rainbow Babies and Children, UHCMC, Cleveland, Ohio
| | | | - Rose A. Gubitosi-Klug
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Rainbow Babies and Children, UHCMC, Cleveland, Ohio
| | | | - Mina K. Divan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jessica Surdam
- University Hospitals Connor Whole Health, Cleveland, Ohio
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Brusco NK, Walpole B, Kugler H, Tilley L, Thwaites C, Devlin A, Dorward E, Dulfer F, Lee AL, Morris ME, Taylor NF, Dawes H, Whittaker SL, Ekegren CL. Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings. Aust Occup Ther J 2023; 70:617-626. [PMID: 37291993 DOI: 10.1111/1440-1630.12891] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Self-directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self-directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self-directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings. METHODS My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open-ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free-text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model). RESULTS Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self-directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self-directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme. CONCLUSION Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale-up the implementation of the My Therapy programme and evaluate its effectiveness.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Brianna Walpole
- Safer Care Victoria, Victorian Government, Melbourne, Australia
| | - Helen Kugler
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Louise Tilley
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Claire Thwaites
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Fiona Dulfer
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Helen Dawes
- Clinical Rehabilitation, University of Exeter, Exeter, UK
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Sharan R, Wiens K, Ronksley PE, Hwang SW, Booth GL, Austin PC, Spackman E, Bai L, Campbell DJT. The Association of Homelessness With Rates of Diabetes Complications: A Population-Based Cohort Study. Diabetes Care 2023; 46:1469-1476. [PMID: 37276538 DOI: 10.2337/dc23-0211] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To estimate the rates of diabetes complications and revascularization procedures among people with diabetes who have experienced homelessness compared with a matched cohort of nonhomeless control subjects. RESEARCH DESIGN AND METHODS A propensity-matched cohort study was conducted using administrative health data from Ontario, Canada. Inclusion criteria included a diagnosis of diabetes and at least one hospital encounter between April 2006 and March 2019. Homeless status was identified using a validated administrative data algorithm. Eligible people with a history of homelessness were matched to nonhomeless control subjects with similar sociodemographic and clinical characteristics. Rate ratios (RRs) for macrovascular complications, revascularization procedures, acute glycemic emergencies, skin/soft tissue infections, and amputation were calculated using generalized linear models with negative binomial distribution and robust SEs. RESULTS Of 1,076,437 people who were eligible for inclusion in the study, 6,944 were identified as homeless. A suitable nonhomeless match was found for 5,219 individuals. The rate of macrovascular complications was higher for people with a history of homelessness compared with nonhomeless control subjects (RR 1.85, 95% CI 1.64-2.07), as were rates of hospitalization for glycemia (RR 5.64, 95% CI 4.07-7.81) and skin/soft tissue infections (RR 3.78, 95% CI 3.31-4.32). By contrast, the rates of coronary revascularization procedures were lower for people with a history of homelessness (RR 0.76, 95% CI 0.62-0.94). CONCLUSIONS These findings contribute to our understanding of the impact of homelessness on long-term diabetes outcomes. The higher rates of complications among people with a history of homelessness present an opportunity for tailored interventions to mitigate these disparities.
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Affiliation(s)
- Ruchi Sharan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Wiens
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Stephen W Hwang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Gillian L Booth
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Peter C Austin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - David J T Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Fu HNC, Wyman JF, Peden-McAlpine CJ, Draucker CB, Schleyer T, Adam TJ. App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy. JMIR Diabetes 2023; 8:e38592. [PMID: 36826987 PMCID: PMC10007004 DOI: 10.2196/38592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/11/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. OBJECTIVE This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. METHODS This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. RESULTS Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. CONCLUSIONS The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication.
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Affiliation(s)
- Helen N C Fu
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Terrence J Adam
- College of Pharmacy, Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, United States
- Institute of Health Informatics, University of Minnesota, Minneapolis, MN, United States
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Kariasa IM, Nurachmah E, Setyowati S, Koestoer RA. The Combination of Sensor Digital Kariasa Early Detection Prototype and Health Education for Self-Management in Preventing Recurrent Ischemic Stroke. SAGE Open Nurs 2022; 8:23779608221143906. [PMID: 36505094 PMCID: PMC9732804 DOI: 10.1177/23779608221143906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Recurrent stroke is one of the concerns that not only causes functional disability but also economic and psychosocial problems. Self-management is one of the indicators to predict recurrent stroke. Field observations indicate there is currently no tool to increase the survivors' self-awareness. Objective The study aimed to investigate if an early detection tool and health education can improve patient self-awareness toward self-management in ischemic stroke patients in order to prevent recurrent ischemic stroke. Methods This study consisted of two stages. In the first stage, the study used research and development methods to develop a digital sensor tool named Sensor Digital Kariasa (SenDiKa). In the second stage, the study used a quasi-experimental design with a pretest-posttest control group involving 44 postischemic stroke patients who were selected by using consecutive sampling. The subjects were divided into intervention and control groups, and the length of the intervention was 12 weeks. Results This study found a significant difference between the two groups (P < .001). The intervention group who used the early detection tool and received health education showed better self-management compared to the control group. The use of SenDiKa early detection prototype and health education for self-management was perceived useful and gave positive effect to the improvement of self-management in poststroke patients to prevent recurrent stroke. Conclusion The combination of SenDiKa early detection prototype and health education for self-management can be used for patients to identify the major risk factors of recurrent stroke, such as blood pressure, blood sugar, and cholesterol.
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Affiliation(s)
- I Made Kariasa
- Faculty of Nursing, Universitas
Indonesia, Depok, West Java, Indonesia,I Made Kariasa, Faculty of Nursing,
Universitas Indonesia, Jl. Prof. DR. Sudjono D. Pusponegoro, Kampus UI Depok,
Jawa Barat 16425, Indonesia.
| | - Elly Nurachmah
- Faculty of Nursing, Universitas
Indonesia, Depok, West Java, Indonesia
| | - S. Setyowati
- Faculty of Nursing, Universitas
Indonesia, Depok, West Java, Indonesia
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Wake AD. Protective effects of physical activity against health risks associated with type 1 diabetes: "Health benefits outweigh the risks". World J Diabetes 2022; 13:161-184. [PMID: 35432757 PMCID: PMC8984568 DOI: 10.4239/wjd.v13.i3.161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
The magnitude of diabetes mellitus (DM) has increased in recent decades, where the number of cases and the proportion of the disease have been gradually increasing over the past few decades. The chronic complications of DM affect many organ systems and account for the majority of morbidity and mortality associated with the disease. The prevalence of type 1 DM (T1DM) is increasing globally, and it has a very significant burden on countries and at an individual level. T1DM is a chronic illness that requires ongoing medical care and patient self-management to prevent complications. This study aims to discuss the health benefits of physical activity (PA) in T1DM patients. The present review article was performed following a comprehensive literature search. The search was conducted using the following electronic databases: "Cochrane Library", Web of Science, PubMed, HINARI, EMBASE, Google for grey literature, Scopus, African journals Online, and Google Scholar for articles published up to June 21, 2021. The present review focused on the effects of PA on many outcomes such as blood glucose (BG) control, physical fitness, endothelial function, insulin sensitivity, well-being, the body defense system, blood lipid profile, insulin resistance, cardiovascular diseases (CVDs), insulin requirements, blood pressure (BP), and mortality. It was found that many studies recommended the use of PA for the effective management of T1DM. PA is a component of comprehensive lifestyle modifications, which is a significant approach for the management of T1DM. It provides several health benefits, such as improving BG control, physical fitness, endothelial function, insulin sensitivity, well-being, and the body defense system. Besides this, it reduces the blood lipid profile, insulin resistance, CVDs, insulin requirements, BP, and mortality. Overall, PA has significant and essential protective effects against the health risks associated with T1DM. Even though PA has several health benefits for patients with T1DM, these patients are not well engaged in PA due to barriers such as a fear of exercise-induced hypoglycemia in particular. However, several effective strategies have been identified to control exercise-induced hypoglycemia in these patients. Finally, the present review concludes that PA should be recommended for the management of patients with T1DM due to its significant health benefits and protective effects against associated health risks. It also provides suggestions for the future direction of research in this field.
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Affiliation(s)
- Addisu Dabi Wake
- Department of Nursing, College of Health Sciences, Arsi University, Asella 193/4, Ethiopia
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Pullyblank K, Scribani M, Wyckoff L, Krupa N, Flynn J, Henderson C, Strogatz D. Evaluating the Implementation of the Diabetes Self-Management Program in a Rural Population. Diabetes Spectr 2022; 35:95-101. [PMID: 35308156 PMCID: PMC8914590 DOI: 10.2337/ds21-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The evidence-based Diabetes Self-Management Program (DSMP) has been shown to improve a variety of health-related outcomes, but the program has been challenging to implement in rural areas, and rural dissemination has been low. The purpose of this project was to evaluate the effect of implementing the DSMP on self-reported outcomes in a rural region. Through a collaboration with multiple partners, the Living Well program delivered 28 DSMP workshops from 2017 to 2019. Data were collected to determine whether there were post-intervention changes in patient-reported outcomes on measures of diabetes distress, self-management, and patient activation. In addition, secondary analysis of A1C was abstracted from the medical records of participants with type 2 diabetes who completed at least four sessions of a DSMP workshop between 2017 and 2019 and whose medical records had an A1C value in the year before the program and at least one A1C value >3 months after the program. Statistically significant improvements were seen for the Diabetes Distress Scale (P = 0.0017), the Diabetes Self-Management Questionnaire (P <0.0001) and the 10-item Patient Activation Measure (P <0.0001). There was no evidence of change in A1C over time in analyses of all participants (P = 0.5875), but a consistent though nonsignificant (P = 0.1087) decline in A1C was seen for a subset of participants with a baseline A1C ≥8%. This evaluation provides preliminary support for implementing the DSMP as part of a comprehensive treatment and self-management plan for people living with diabetes in rural areas.
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Timm L, Karlsson I, Sidney Annerstedt K, Absetz P, Forsberg BC, Daivadanam M, Mølsted Alvesson H. Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients 2021; 13:3862. [PMID: 34836116 PMCID: PMC8618573 DOI: 10.3390/nu13113862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants' needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery.
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Affiliation(s)
- Linda Timm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | - Ida Karlsson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | | | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 751 22 Uppsala, Sweden
| | - Helle Mølsted Alvesson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
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Bergmame L, Shaw S. Clinical Utility of Psychoeducational Interventions for Youth with Type 1 Diabetes: A Scoping Review. CONTINUITY IN EDUCATION 2021; 2:76-108. [PMID: 38774890 PMCID: PMC11104390 DOI: 10.5334/cie.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/03/2021] [Indexed: 05/24/2024]
Abstract
Adolescence is a challenging time for the medical management of type 1 diabetes. Thus, a range of psychoeducational interventions have been developed to improve diabetes management among youth. Systematic reviews of this literature have emphasized the effectiveness of interventions for improving patient outcomes. However, knowledge beyond what works is required for interventions to be adopted into routine clinical practice. The objective of this scoping review was to map the clinical utility of the literature based on a variety of indicators, including the problem base, context placement, information gain, transparency, pragmatism, and patient-centeredness of the research. This lens for reviewing research is consistent with the biopsychosocial model and an increasing focus on reducing disability, including activity limitation and participation restriction. PsycINFO, MEDLINE, and CINHAL databases were searched for evaluative psychoeducational intervention studies published between January 2005 and October 2020. Two cited reference searches and one reference list search were also performed. Fifty studies describing 46 different interventions were identified. The clinical utility of the interventions was highly variable. A detailed overview of the clinical utility of the literature is provided with an emphasis on current gaps and shortcomings to be addressed in future research. This work helps advance the translation of clinical knowledge into practice in schools, homes, and communities; and, ultimately, improve the health and well-being of adolescents with T1D.
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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Aminuddin HB, Jiao N, Jiang Y, Hong J, Wang W. Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: A systematic review and meta-analysis. Int J Nurs Stud 2021; 116:103286. [PMID: 30827741 DOI: 10.1016/j.ijnurstu.2019.02.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life, glycated hemoglobin, body mass index (BMI), and blood pressure (BP) levels of adults with type 2 diabetes mellitus . METHODS A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Studies published in English from January 2007 to January 2018 were considered. Only randomized controlled trials (RCTs) of smartphone-based self-management interventions for patients with type 2 diabetes mellitus that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes. RESULTS A total of 26 articles, consisting of 22 studies with 2645 participants, were included in the review. The results from meta-analysis on the studies revealed that as compared to control group, participants received smartphone-based self-management intervention had better self-efficacy with large effect size of 0.98 (P < 0.001), self-care activities with effect size of 0.90 (P < 0.001), health related quality of life with effect size of 0.26 (p=0.01), and lower glycated hemoglobin (pooled MD=-0.55; p<0.001). Subgroup analyses were also conducted for self-efficacy as significant heterogeneity was present among the studies. The effects on BMI and BP were not statistically significant. CONCLUSIONS Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with type 2 diabetes mellitus. However, more research with good study design is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM.
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Affiliation(s)
- Haziqah Binte Aminuddin
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Nana Jiao
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Tanaka R, Shibayama T, Sugimoto K, Hidaka K. Diabetes self-management education and support for adults with newly diagnosed type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2020; 169:108480. [PMID: 33002545 DOI: 10.1016/j.diabres.2020.108480] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
This systematic review aimed to identify the effectiveness of diabetes self-management education and support (DSMES) among adults within 12 months of diagnosis of type 2 diabetes mellitus (T2DM). We searched the Cochrane Library, MEDLINE, CINAHL, PsycINFO, ERIC, and other sources up to March 2019 to detect randomized controlled trials in the last decade based on the global guidelines' definition of DSMES. Data were categorized into biomedical, psychosocial, and behavioral outcomes and synthesized using a random-effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. We scrutinized 12 studies that enrolled 2,386 adults with newly diagnosed T2DM. Biomedical outcomes presented the pooled effects of HbA1c -0.21% (95% confidence interval, -0.38, -0.04), body weight -2.36 kg (-5.77, 1.05), and waist circumference -1.8 cm (-5.63, 2.04) when the data from the two studies with low risk of bias were combined (N = 1,082). Psychosocial and behavioral effects were inconclusive owing to mixed results from various scales and reporting. The quality of the body of evidence was low. DSMES within 12 months of T2DM diagnosis might affect patient-centered outcomes. Further studies with higher precision using standardized measurement methods are required.
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Affiliation(s)
- Rie Tanaka
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Taiga Shibayama
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Keiko Sugimoto
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kikue Hidaka
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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13
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Diabetes management interventions for homeless adults: a systematic review. Int J Public Health 2020; 65:1773-1783. [PMID: 33095271 PMCID: PMC7716851 DOI: 10.1007/s00038-020-01513-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Recent studies investigating diabetes show that inequalities to access appropriate care still persists. Whilst most of the general population are able to access a suitable quality of care, there are a number of groups who fail to receive the same standard. The objective of this review was to identify existing diabetes management interventions for homeless adults. METHODS A literature search was conducted in February 2017, and repeated in September 2020. RESULTS Of the 223 potentially relevant articles identified, only 26 were retrieved for detailed evaluation, and 6 met the inclusion criteria. Papers focusing on the management of diabetes in homeless people were included. The studies used interventions including diabetes education; medication support and supplies for blood monitoring; improvements in self-care behaviours; improvements in diabetes control; patient empowerment/engagement; and community engagement/partnerships. CONCLUSIONS Effective strategies for addressing the challenges and obstacles that the homeless population face, requires innovative, multi-sectored, flexible and well-coordinated models of care. Without appropriate support, these groups of people are prone to experience poor control of their diabetes; resulting in an increased risk of developing major health complications.
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Determinants of glycaemic control among patients with type 2 diabetes: testing a process model based on self-determination theory. Heliyon 2020; 6:e04993. [PMID: 33083586 PMCID: PMC7553979 DOI: 10.1016/j.heliyon.2020.e04993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/16/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
Aims To investigate a hypothesised process model based on self-determination theory (SDT) in a population of people with type 2 diabetes. The model suggests that autonomy support from healthcare professionals is an important determinant of autonomous motivation and perceived competence in diabetes, which correlate positively in turn with wellbeing and negatively with HbA1c. Methods This cross-sectional study used baseline questionnaire data and HbA1c levels from a randomised controlled trial investigating the effects of a person-centred consultation program. The questionnaire used validated scales and items assessing autonomy support, wellbeing, motivation, self-care activities, diabetes distress and perceived competence. Pearson correlations were calculated, and mediation analysis was conducted by multivariate linear regression analysis. Results 116 participants completed the questionnaire. Autonomy support was significantly correlated with perceived competence and controlled motivation. Perceived competence correlated negatively with diabetes distress and positively with self-care activities. Diabetes distress correlated negatively with wellbeing. Controlled motivation correlated positively with autonomous motivation, which correlated positively with both wellbeing and self-care activities. Self-care activities correlated negatively with HbA1c. Conclusion As suggested by the hypothesised SDT process model, autonomy support, autonomous motivation and perceived competence are associated with better wellbeing and improved HbA1c.
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15
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Wake AD. Antidiabetic Effects of Physical Activity: How It Helps to Control Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:2909-2923. [PMID: 32884317 PMCID: PMC7443456 DOI: 10.2147/dmso.s262289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the improvements in clinical care of the patients, research updates, and public health interventions, there is still an increase in the prevalence, incidence, and mortality because of diabetes mellitus (DM). DM is a public health problem in both developed and developing countries. It has increased alarmingly, putting this disease in the dimension of an epidemic. Diabetes is associated with several complications which increase the risk of many serious health problems on the other side. Therefore, this review was aimed to discuss the antidiabetic effects of physical activity (PA) on type 2 DM (T2DM) by summarizing the significant studies on this topic. This review found that several studies have recommended the utilization of PA for the effective management of T2DM. PA is a non-pharmacologic therapy which is a significant strategy for the management of T2DM and is an appropriate lifestyle modification approach to be practiced by these patients. The studies showed that PA has antidiabetic effects which are evidenced by its substantial role in improving the blood glucose (BG) levels of the individuals with T2DM where it helps them to control their levels of glucose in the blood. It plays a significant role in glycemic control of this disease by lowering the BG levels through possible mechanisms such as decreasing insulin resistance, increasing production of glucose transporter type 4 (GLUT-4), lowering visceral adipose tissue (VAT), increasing pancreatic β-cell functions, using glucose for energy, and so on. In turn, the controlled glycemia helps to prevent the complications associated with uncontrolled T2DM and this would further improve the overall health of the patients and the burden on the health professionals as well. Finally, this review concludes that PA is the cornerstone in the management of T2DM. It also suggests that more attention is needed to its significance in the prevention, glycemic control, and its role in the management of the morbidity and mortality associated with T2DM. Practical PA recommendations and suggestions for the future direction of research in this area are also provided.
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Assela, Oromia, Ethiopia
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Usability Evaluation of Four Top-Rated Commercially Available Diabetes Apps for Adults With Type 2 Diabetes. Comput Inform Nurs 2020; 38:274-280. [PMID: 31904594 DOI: 10.1097/cin.0000000000000596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite the many diabetes applications available, the rate of use is low, which may be associated with design issues. This study examined app usability compliance with heuristic design principles, guided by the Self-determination Theory on motivation. Four top-rated commercially available apps (Glucose Buddy, MyNetDiary, mySugr, and OnTrack) were tested for data recording, blood glucose analysis, and data sharing important for diabetes competence, autonomy, and connection with a healthcare provider. Four clinicians rated each app's compliance with Nielsen's 10 principles and its usability using the System Usability Scale. All four apps lacked one task function related to diabetes care competence or autonomy. Experts ranked app usability rated with the System Usability Scale: OnTrack (61) and Glucose Buddy (60) as a "D" and MyNetDairy (41) and mySugr (15) as an "F." A total of 314 heuristic violations were identified. The heuristic principle violated most frequently was "Help and Documentation" (n = 50), followed by "Error Prevention" (n = 45) and "Aesthetic and Minimalist Design" (n = 43). Four top-rated diabetes apps have "marginally acceptable" to "completely unacceptable." Future diabetes app design should target patient motivation and incorporate key heuristic design principles by providing tutorials with a help function, eliminating error-prone operations, and providing enhanced graphical or screen views.
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Shrestha M, Ng AH, Gray RJ. Association between subthreshold depression and self-care behaviours in adults with type 2 diabetes: A protocol for a cross-sectional study. J Clin Nurs 2020; 30:2453-2461. [PMID: 32415880 DOI: 10.1111/jocn.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/05/2020] [Accepted: 03/14/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the association between subthreshold depression and self-care behaviours in adults with type 2 diabetes (T2D) attending a tertiary healthcare service. BACKGROUND Diabetes is a global public health problem. Self-care behaviours are a fundamental element in managing diabetes as adherence to self-care activities is associated with improved glycaemic control. Depression in T2D is associated with decreased adherence to self-care behaviours. Adults with subthreshold depression in diabetes may have difficulties in achieving metabolic control. Further, people with subthreshold depression have an increased risk of developing major depression. Few studies have examined the association between subthreshold depression and self-care behaviours. DESIGN A cross-sectional study. METHODS The study will be conducted among 384 adults diagnosed with T2D for at least a year attending their routine outpatient appointment at Tribhuvan University Teaching Hospital in Nepal. Convenience sampling will be used to recruit study participants. Data will be collected via face-to-face interviews and a medical record review. Self-care behaviours will be assessed using the Summary of Diabetes Self-care activities and subthreshold depression will be determined using the Patient Health Questionnaire- 9. Covariates in the study include sociodemographic and clinical factors, diabetes knowledge, perceived social support and self-efficacy. This paper complies with the STROBE reporting guideline for cross-sectional studies. RESULTS We will use multiple linear regression to examine the association between subthreshold depression and each self-care behaviours (i.e. diet, physical activity, foot care, blood glucose testing and medication) and total self-care behaviour. CONCLUSIONS Effective management of diabetes requires adherence to self-care behaviours. The findings of the study will help in identifying an effective way to improve diabetes self-care. RELEVANCE TO CLINICAL PRACTICE Our observations will inform nursing research and practice by providing evidence about how subthreshold depression may influence self-care behaviours.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Richard J Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
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Radhakrishnan K, Kim MT, Burgermaster M, Brown RA, Xie B, Bray MS, Fournier CA. The potential of digital phenotyping to advance the contributions of mobile health to self-management science. Nurs Outlook 2020; 68:548-559. [PMID: 32402392 DOI: 10.1016/j.outlook.2020.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
Digital phenotyping consists of moment-by-moment quantification of behavioral data from individual people, typically collected passively from smartphones and other sensors. Within the evolving context of precision health, digital phenotyping can advance the use of mobile health -based self-management tools and interventions by enabling more accurate prediction for prevention and treatment, facilitating supportive strategies, and informing the development of features to motivate self-management behaviors within real-world conditions. This represents an advancement in self-management science: with digital phenotyping, nurse scientists have opportunities to tailor interventions with increased precision. In this paper, we discuss the emergence of digital phenotyping, the historical background of ecological momentary assessment, and the current state of the science of digital phenotyping, with implications for research design, computational requirements, and ethical considerations in self-management science, as well as limitations.
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Affiliation(s)
| | - Miyong T Kim
- School of Nursing, The University of Texas - Austin, Austin, TX
| | - Marissa Burgermaster
- Department of Population Health, The University of Texas - Austin, Austin, TX; Department of Nutritional Sciences, The University of Texas - Austin, Austin, TX
| | | | - Bo Xie
- School of Nursing, The University of Texas - Austin, Austin, TX; School of Information, The University of Texas - Austin, Austin, TX
| | - Molly S Bray
- School of Nutrition, Department of Pediatrics, The University of Texas - Austin, Austin, TX
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Grønnegaard C, Varming A, Skinner T, Olesen K, Willaing I. WITHDRAWN: Determinants of glycaemic control among patients with type 2 diabetes: Testing a process model based on self-determination theory. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.jecr.2020.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Shrestha M, Ng A, Al-Ghareeb A, Alenazi F, Gray R. Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies. Syst Rev 2020; 9:45. [PMID: 32113485 PMCID: PMC7049390 DOI: 10.1186/s13643-020-01302-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Self-care behaviors in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviors. The association between subthreshold depression and self-care behaviors, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviors. METHODS A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviors, were included in the review. Qualitative studies, review articles, and gray literature were excluded. Two reviewers independently completed the title and abstract and full-text screening, appraised the study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted because criteria for conducting such analyses were not met. RESULTS A total of 6408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. Both studies showed inconsistent findings in the association between subthreshold depression and self-care behaviors. Important risks of bias were identified in the included studies. DISCUSSION The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviors in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviors in people with type 2 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018116373.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia. .,Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal.
| | - Ashley Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | - Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,University of South Australia, Adelaide, Australia.,University of Essex, Colchester, Essex, UK
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The development of My Care Hub Mobile-Phone App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes. Sci Rep 2020; 10:7. [PMID: 31913296 PMCID: PMC6949290 DOI: 10.1038/s41598-019-56411-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
Non-adherence to self-management poses a serious risk to diabetes complications. Digital behavioural change interventions have the potential to provide education and motivate users to regularly engage with self-management of diabetes. This paper describes the development of My Care Hub mobile phone application (app) aimed at supporting self-management in people with type 1 or type 2 diabetes. The development of My Care Hub involved a comprehensive process of healthy behavioural change identification, end users’ needs, expert consensus, data security and privacy considerations. The app translation was a highly iterative process accompanied by usability testing and design modification. The app development process included: (1) behaviour change strategy selection; (2) users’ involvement; (3) expert advisory involvement; (4) data security and privacy considerations; (5) design creation and output translation into a smartphone app and (6) two usability testings of the app prototype version. The app features include self-management activities documentation, analytics, personalized and generalized messages for diabetes self-management as well as carbohydrate components of common foods in Australia. Twelve respondents provided feedback on the usability of the app. Initially, a simplification of the documentation features of the app was identified as a need to improve usability. Overall, results indicated good user satisfaction rate.
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Jeihooni AK, Khiyali Z, Faghih F, Harsini PA, Rahbar M. The Effect of Educational Program Based on the Extended Theory of Reasoned Action on Self-Care Behaviors in Women with Type 2 Diabetes. Indian J Endocrinol Metab 2019; 23:609-615. [PMID: 32042696 PMCID: PMC6987776 DOI: 10.4103/ijem.ijem_439_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to determine the effect of educational program based on the extended theory of reasoned action on self-care behaviours in women with type 2 diabetes in Fasa. This quasi-experimental study was performed on 100 women with type 2 diabetes who referred to diabetes clinics in Fasa. MATERIALS AND METHODS Samples were randomly divided into experimental and control groups. The data were collected using a questionnaire based on the extended theory of reasoned action and self-care behaviours that were completed by both the control and experimental groups before and 3 months after the educational intervention. Data were analysed by SPSS software version 22, descriptive statistics tests, Chi-square test, independent T-test, and paired T-test. RESULTS The results of the study showed that after the educational intervention, the mean scores of all constructs of the extended theory of reasoned action in the experimental group were significantly increased compared to the control group (P <0.05). CONCLUSION Also, the educational intervention had a significant effect on the promotion of patient's self-care behaviours in the experimental group and the HbA1c level decreased in the experimental group compared to the control group (P <0.05). In addition, it was found that the extended theory of reasoned action could be a suitable framework for designing educational interventions for promoting self-care behaviours in diabetic patients.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Zahra Khiyali
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Forough Faghih
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Rahbar
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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Agarwal G, Gaber J, Richardson J, Mangin D, Ploeg J, Valaitis R, Reid GJ, Lamarche L, Parascandalo F, Javadi D, O'Reilly D, Dolovich L. Pilot randomized controlled trial of a complex intervention for diabetes self-management supported by volunteers, technology, and interprofessional primary health care teams. Pilot Feasibility Stud 2019; 5:118. [PMID: 31673398 PMCID: PMC6815451 DOI: 10.1186/s40814-019-0504-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background Most health care for people with diabetes occurs in family practice, yet balancing the time and resources to help these patients can be difficult. An intervention empowering patients, leveraging community resources, and assisting self-management could benefit patients and providers. Thus, the feasibility and potential for effectiveness of “Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management” (Health TAPESTRY-HC-DM) as an approach supporting diabetes self-management was explored to inform development of a future large-scale trial. Methods Four-month pilot randomized controlled trial (RCT), sequential explanatory qualitative component. Participants—patients of an interprofessional primary care team—were over age 18 years, diagnosed with diabetes and hypertension, and had Internet access and one of the following: uncontrolled HbA1c, recent diabetes diagnosis, end-stage/secondary organ damage, or provider referral. The Health TAPESTRY-HC-DM intervention focused on patient health goals/needs, integrating community volunteers, eHealth technologies, interprofessional primary care teams, and system navigation. Pilot outcomes included process measures (recruitment, retention, program participation), perceived program feasibility, benefits and areas for improvement, and risks or safety issues. The primary trial outcome was self-efficacy for managing diabetes. There were a number of secondary trial outcomes. Results Of 425 eligible patients invited, 50 signed consent (11.8%) and 35 completed the program (15 intervention, 20 control). Volunteers (n = 20) met 28 clients in 234 client encounters (home visits, phone calls, electronic messages); 27 reports were sent to the interprofessional team. At 4 months, controlling for baseline, most outcomes were better in the intervention compared to control group; physical activity notably better. The most common goal domains set were physical activity, diet/nutrition, and social connection. Clients felt the biggest impact was motivation toward goal achievement. They struggled with some of the technologies. Several participants perceived that the program was not a good fit, mostly those that felt they were already well-managing their diabetes. Conclusions Health TAPESTRY-HC-DM was feasible; a large-scale randomized controlled trial seems possible. However, further attention needs to be paid to improving recruitment and retention. The intervention was well received, though was a better fit for some participants than others. Trial registration ClinicalTrials.gov, NCT02715791. Registered 22 March 2016—retrospectively registered.
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Affiliation(s)
- Gina Agarwal
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Jessica Gaber
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Julie Richardson
- 2School of Rehabilitation Science, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Dee Mangin
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Jenny Ploeg
- 3Department of Health, Aging and Society, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.,4School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Ruta Valaitis
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.,4School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Graham J Reid
- 5Departments of Psychology, Family Medicine, & Paediatrics, The University of Western Ontario, Westminster Hall, Room 319E, London, Ontario N6A 3K7 Canada
| | - Larkin Lamarche
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Fiona Parascandalo
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Dena Javadi
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Daria O'Reilly
- 6Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL, 2nd Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Lisa Dolovich
- 1Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
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Saidi S, Milnes LJ, Griffiths J. Are we doing it right? Self-care support for patients with type 2 diabetes in urban areas in Malaysia. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Yu DSF, Li PWC, Yue SCS, Wong J, Yan B, Tsang KK, Choi KC. The effects and cost‐effectiveness of an empowerment‐based self‐care programme in patients with chronic heart failure: A study protocol. J Adv Nurs 2019; 75:3740-3748. [DOI: 10.1111/jan.14162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Doris S. F. Yu
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Polly W. C. Li
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Sunny C. S. Yue
- Department of Medicine and Geriatrics United Christian Hospital Kwun Tong Hong Kong
| | - John Wong
- Division of Cardiology, Department of Medicine and Geriatrics Tseung Kwan O Hospital Tseung Kwan O Hong Kong
| | - Bryan Yan
- Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin Hong Kong
| | | | - Kai Chow Choi
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
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House A, Bryant L, Russell AM, Wright-Hughes A, Graham L, Walwyn R, Wright JM, Hulme C, O'Dwyer JL, Latchford G, Meer S, Birtwistle JC, Stansfield A, Ajjan R, Farrin A. Managing with Learning Disability and Diabetes: OK-Diabetes - a case-finding study and feasibility randomised controlled trial. Health Technol Assess 2019; 22:1-328. [PMID: 29845932 DOI: 10.3310/hta22260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obesity and type 2 diabetes are common in adults with a learning disability. It is not known if the principles of self-management can be applied in this population. OBJECTIVES To develop and evaluate a case-finding method and undertake an observational study of adults with a learning disability and type 2 diabetes, to develop a standardised supported self-management (SSM) intervention and measure of adherence and to undertake a feasibility randomised controlled trial (RCT) of SSM versus treatment as usual (TAU). DESIGN Observational study and an individually randomised feasibility RCT. SETTING Three cities in West Yorkshire, UK. PARTICIPANTS In the observational study: adults aged > 18 years with a mild or moderate learning disability, who have type 2 diabetes that is not being treated with insulin and who are living in the community. Participants had mental capacity to consent to research and to the intervention. In the RCT participants had glycated haemoglobin (HbA1c) levels of > 6.5% (48 mmol/mol), a body mass index (BMI) of > 25 kg/m2 or self-reported physical activity below national guideline levels. INTERVENTIONS Standardised SSM. TAU supported by an easy-read booklet. MAIN OUTCOME MEASURES (1) The number of eligible participants identified and sources of referral; (2) current living and support arrangements; (3) current health state, including level of HbA1c, BMI and waist circumference, blood pressure and lipids; (4) mood, preferences for change; (5) recruitment and retention in RCT; (6) implementation and adherence to the intervention; (7) completeness of data collection and values for candidate primary outcomes; and (8) qualitative data on participant experience of the research process and intervention. RESULTS In the observational study we identified 147 eligible consenting participants. The mean age was 54.4 years. In total, 130 out of 147 (88%) named a key supporter, with 113 supporters (77%) being involved in diabetes management. The mean HbA1c level was 54.5 mmol/mol [standard deviation (SD) 14.8 mmol/mol; 7.1%, SD 1.4%]. The BMI of 65% of participants was > 30 kg/m2 and of 21% was > 40 kg/m2. Many participants reported low mood, dissatisfaction with lifestyle and diabetes management and an interest in change. Non-response rates were high (45/147, 31%) for medical data requested from the primary care team. In the RCT, 82 participants were randomised. The mean baseline HbA1c level was 56 mmol/mol (SD 16.5 mmol/mol; 7.3%, SD 1.5%) and the mean BMI was 34 kg/m2 (SD 7.6 kg/m2). All SSM sessions were completed by 35 out of 41 participants. The adherence measure was obtained in 37 out of 41 participants. The follow-up HbA1c level and BMI was obtained for 75 out of 82 (91%) and 77 out of 82 (94%) participants, respectively. Most participants reported a positive experience of the intervention. A low response rate and difficulty understanding the EuroQol-5 Dimensions were challenges in obtaining data for an economic analysis. LIMITATIONS We recruited from only 60% of eligible general practices, and 90% of participants were on a general practice learning disability register, which meant that we did not recruit many participants from the wider population with milder learning disability. CONCLUSIONS A definitive RCT is feasible and would need to recruit 194 participants per arm. The main barrier is the resource-intensive nature of recruitment. Future research is needed into the effectiveness of obesity treatments in this population, particularly estimating the longer-term outcomes that are important for health benefit. Research is also needed into improving ways of assessing quality of life in adults with a learning disability. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amy M Russell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Liz Graham
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John L O'Dwyer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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Öberg U, Isaksson U, Jutterström L, Orre C, Hörnsten Å. Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10250. [PMID: 30958279 PMCID: PMC6475816 DOI: 10.2196/10250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/17/2018] [Accepted: 08/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs. OBJECTIVE To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care. METHODS This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA1c) will be the primary outcome measure. RESULTS This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019. CONCLUSIONS This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10250.
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Affiliation(s)
- Ulrika Öberg
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Carljohan Orre
- Department of Computer Science and Media Technology, Malmö University, Malmö, Sweden
| | - Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
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Validation of the Knowledge and Self-management Nursing Outcomes Classification for Adults With Diabetes. ACTA ACUST UNITED AC 2019; 37:222-228. [DOI: 10.1097/cin.0000000000000495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Moyano D, Morelli D, Santero M, Belizan M, Irazola V, Beratarrechea A. Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study. JMIR Diabetes 2019; 4:e10350. [PMID: 30882362 PMCID: PMC6441856 DOI: 10.2196/10350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/27/2018] [Accepted: 12/28/2018] [Indexed: 01/25/2023] Open
Abstract
Background Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. Objective The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. Methods A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. Results Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient’s learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. Conclusions Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients.
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Affiliation(s)
- Daniela Moyano
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Daniela Morelli
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Belizan
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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30
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Milo RB, Connelly CD. Predictors of glycemic management among patients with type 2 diabetes. J Clin Nurs 2019; 28:1737-1744. [DOI: 10.1111/jocn.14779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 10/25/2018] [Accepted: 12/05/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Razel B. Milo
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research University of San Diego San Diego California
| | - Cynthia D. Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research University of San Diego San Diego California
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Captieux M, Pearce G, Parke HL, Epiphaniou E, Wild S, Taylor SJC, Pinnock H. Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews. BMJ Open 2018; 8:e024262. [PMID: 30552277 PMCID: PMC6303627 DOI: 10.1136/bmjopen-2018-024262] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom. DESIGN A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology. SETTING AND PARTICIPANTS Eight databases were searched for systematic reviews of RCTs from January 1993 to October 2016, with a pre-publication update in April 2017. Forward citation was performed on included reviews in Institute for Scientific Information (ISI) Proceedings. We extracted data and assessed quality with the Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR). PRIMARY AND SECONDARY OUTCOME MEASURES Glycaemic control as measured by glycated haemoglobin (HbA1c) was the primary outcome. Body mass Index, lipid profiles, blood pressure and quality of life scoring were secondary outcomes. Meta-analyses reporting HbA1c were summarised in meta-forest plots; other outcomes were synthesised narratively. RESULTS 41 systematic reviews incorporating data from 459 unique RCTs in diverse socio-economic and ethnic communities across 33 countries were included. R-AMSTAR quality score ranged from 20 to 42 (maximum 44). Apart from one outlier, the majority of reviews found an HbA1c improvement between 0.2% and 0.6% (2.2-6.5 mmol/mol) at 6 months post-intervention, but attenuated at 12 and 24 months. Impact on secondary outcomes was inconsistent and generally non-significant. Diverse self-management support strategies were employed; no single approach appeared optimally effective (or ineffective). Effective programmes tended to be multi-component and provide adequate contact time (>10 hours). Technology-facilitated self-management support showed a similar impact as traditional approaches (HbA1c MD -0.21% to -0.6%). CONCLUSIONS Self-management interventions using a range of approaches improve short-term glycaemic control in people with type 2 diabetes including culturally diverse populations. These findings can inform researchers, policy-makers and healthcare professionals re-evaluating the provision of self-management support in routine care. Further research should consider implementation and sustainability.
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Affiliation(s)
- Mireille Captieux
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Gemma Pearce
- Coventry University, Centre for Advances in Behavioural Science, Coventry, UK
| | - Hannah L Parke
- University of Exeter Biomedical Informatics Hub, Exeter, Devon, UK
| | - Eleni Epiphaniou
- University of Nicosia, Department of Social Sciences, Nicosia, Cyprus
| | - Sarah Wild
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Kanera IM, van Laake-Geelen CCM, Ruijgrok JM, Goossens MEJB, de Jong JR, Verbunt JA, Geerts M, Smeets RJEM, Kindermans HPJ. Living with painful diabetic neuropathy: insights from focus groups into fears and coping strategies. Psychol Health 2018; 34:84-105. [PMID: 30320508 DOI: 10.1080/08870446.2018.1518526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN. DESIGN Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N = 12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach. MAIN OUTCOME MEASURES Fears and coping strategies related to PA in persons with PDN. RESULTS Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described. CONCLUSION In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN.
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Affiliation(s)
- Iris M Kanera
- a Research Centre for Nutrition, Lifestyle, and Exercise, Faculty of Health , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands
| | - Charlotte C M van Laake-Geelen
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Department of Rehabilitation Medicine , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.,d Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , The Netherlands
| | - Joop M Ruijgrok
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,e Neurorehabilitation Centre , Klinik Bethesda Tschugg , Tschugg , Switzerland
| | - Marielle E J B Goossens
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands
| | - Jeroen R de Jong
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Department of Rehabilitation Medicine , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Jeanine A Verbunt
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,c Department of Rehabilitation Medicine , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.,d Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , The Netherlands
| | - Margot Geerts
- f Department of Neurology , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Rob J E M Smeets
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,g Libra Rehabilitation and Audiology , Eindhoven , The Netherlands
| | - Hanne P J Kindermans
- b Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands.,h Department of Clinical Psychological Science , Maastricht University , Maastricht , The Netherlands
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Gurmu Y, Gela D, Aga F. Factors associated with self-care practice among adult diabetes patients in West Shoa Zone, Oromia Regional State, Ethiopia. BMC Health Serv Res 2018; 18:732. [PMID: 30249246 PMCID: PMC6154910 DOI: 10.1186/s12913-018-3448-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes, a rising global health problem, requires continuous self-care practice to prevent acute and chronic complications. However, studies show that few diabetes patients practice the recommended self-care in Ethiopia. The aim of this study was to assess factors associated with self-care practice among adult diabetes patients in public hospitals of West Shoa Zone, Oromia Regional State, Ethiopia. METHODS In this cross-sectional study, 257 diabetes patients (mean age 42.9 ± 14.6 years, 54.1% male) completed the survey in Afan Oromo and Amharic languages. A questionnaire consisting standardized tools was used to collect the data. Descriptive and logistic regression analyses were conducted using SPSS version 21. RESULTS The mean score for diabetes self-care was 39.8 ± 9.5 and 45.5% of the participants scored below the mean. Multiple logistic regression analysis revealed that having higher diabetes knowledge (AOR = 2.42, 95% CI = 1.22, 4.80), self-efficacy (AOR = 3.30, 95% CI = 1.64, 6.62), social support (AOR = 2.86, 95% CI = 1.37, 5.96), secondary school education (AOR = 6.0, 95% CI = 1.90, 18.85), and longer duration of diabetes (AOR = 5.55, 95% CI = 2.29, 13.44) were important predictors of good diabetes self-care practice. CONCLUSION The diabetes education programs should use strategies that enhance patients' diabetes knowledge, self-efficacy, and social support. Patients with recent diabetes diagnosis need special attention as they may relatively lack knowledge and skills in self-care. Further studies are needed to elucidate pathways through which diabetes knowledge, self-efficacy, social support, and health literacy affect diabetes self-care.
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Affiliation(s)
- Yonas Gurmu
- Department of Nursing, College of Medicine & Health Sciences, Ambo University, P. O. Box: 19, Ambo, Ethiopia
| | - Debela Gela
- Department of Nursing & Midwifery, School of Allied Health Sciences, College of Health Science, Addis Ababa University, P.O. Box: 4412, Addis Ababa, Ethiopia
| | - Fekadu Aga
- Department of Nursing & Midwifery, School of Allied Health Sciences, College of Health Science, Addis Ababa University, P.O. Box: 9083, Addis Ababa, Ethiopia
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Taggart L, Truesdale M, Dunkley A, House A, Russell AM. Health Promotion and Wellness Initiatives Targeting Chronic Disease Prevention and Management for Adults with Intellectual and Developmental Disabilities: Recent Advancements in Type 2 Diabetes. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:132-142. [PMID: 30148038 PMCID: PMC6096852 DOI: 10.1007/s40474-018-0142-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this paper was to review the recent international developments in health promotion and wellness initiatives targeting chronic disease prevention and management for adults with intellectual and developmental disabilities (IDD) targeting type 2 diabetes (T2D). RECENT FINDINGS There has been one diabetes prevention program (STOP) and two self-management T2D education programs (DESMOND-ID; OK diabetes) adapted for this population. All three programs have been adapted from other theoretically informed and tested programs developed for the general population. Each program has employed co-design and co-production techniques with all stakeholders. The three programs all target the high-risk lifestyle factors that can lead to T2D and contribute to poor glycaemia control, and have undertaken randomized-feasibility studies, the results of which are promising. SUMMARY This paper shows that any health promotion and wellness initiatives need to be tailored and reasonable adjustments made in order to address this population's cognitive impairments and communication difficulties.
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Affiliation(s)
- L. Taggart
- Institute of Nursing & Health Research, Ulster University, Room 12J19, Shore Road, Newtownabbey, Co Antrim BT37 0QB Northern Ireland
| | - M. Truesdale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - A. Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, England
| | - A. House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - A. M. Russell
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Adu MD, Malabu UH, Callander EJ, Malau-Aduli AE, Malau-Aduli BS. Considerations for the Development of Mobile Phone Apps to Support Diabetes Self-Management: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e10115. [PMID: 29929949 PMCID: PMC6035345 DOI: 10.2196/10115] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/30/2018] [Accepted: 04/25/2018] [Indexed: 12/16/2022] Open
Abstract
Background There is increased research interest in the use of mobile phone apps to support diabetes management. However, there are divergent views on what constitute the minimum standards for inclusion in the development of mobile phone apps. Mobile phone apps require an evidence-based approach to development which will consequently impact on their effectiveness. Therefore, comprehensive information on developmental considerations could help designers and researchers to develop innovative and effective patient-centered self-management mobile phone apps for diabetes patients. Objective This systematic review examined the developmental considerations adopted in trials that engaged mobile phone applications for diabetes self-management. Methods A comprehensive search strategy was implemented across 5 electronic databases; Medline, Scopus, Social Science Citation Index, the Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature (CINALHL) and supplemented by reference list from identified studies. Study quality was evaluated using the Joanna Briggs Critical appraisal checklist for trials. Information on developmental factors (health behavioral theory, functionality, pilot testing, user and clinical expert involvements, data privacy and app security) were assessed across experimental studies using a template developed for the review. Results A total of 11 studies (10 randomized controlled trials and 1 quasi-experimental trial) that fitted the inclusion criteria were identified. All the included studies had the functionality of self-monitoring of blood glucose. However, only some of them included functions for data analytics (7/11, 63.6%), education (6/11, 54.5%) and reminder (6/11, 54.5%). There were 5/11(45.5%) studies with significantly improved glycosylated hemoglobin in the intervention groups where educational functionality was present in the apps used in the 5 trials. Only 1 (1/11, 9.1%) study considered health behavioral theory and user involvement, while 2 (2/11, 18.1%) other studies reported the involvement of clinical experts in the development of their apps. There were 4 (4/11, 36.4%) studies which referred to data security and privacy considerations during their app development while 7 (7/12, 63.6%) studies provided information on pilot testing of apps before use in the full trial. Overall, none of the studies provided information on all developmental factors assessed in the review. Conclusions There is a lack of elaborate and detailed information in the literature regarding the factors considered in the development of apps used as interventions for diabetes self-management. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of practical and user-friendly self-management apps that can enhance the quality of life for diabetes patients.
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Affiliation(s)
- Mary D Adu
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Usman H Malabu
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Emily J Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Aduli Eo Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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House A, Bryant L, Russell AM, Wright‐Hughes A, Graham L, Walwyn R, Wright JM, Hulme C, O'Dwyer JL, Latchford G, Stansfield A, Ajjan R, Farrin A. Randomized controlled feasibility trial of supported self-management in adults with Type 2 diabetes mellitus and an intellectual disability: OK Diabetes. Diabet Med 2018; 35:776-788. [PMID: 29575241 PMCID: PMC5969288 DOI: 10.1111/dme.13626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 01/21/2023]
Abstract
AIMS To undertake a feasibility randomized controlled trial of supported self-management vs treatment as usual in a population of adults with obesity, Type 2 diabetes and an intellectual disability. METHODS We conducted an individually randomized feasibility trial. Participants were adults aged >18 years with a mild or moderate intellectual disability, living in the community with Type 2 diabetes, on any therapy other than insulin. Participants had mental capacity to consent to research and the intervention. Inclusion criteria included HbA1c > 48 mmol/mol (6.5%), BMI >25 kg/m2 , or self-reported physical activity below national guideline levels. The experimental intervention was standardized supported self-management delivered by diabetes specialist nurses plus treatment as usual, compared with treatment as usual alone. Feasibility outcomes included: recruitment and retention; intervention acceptability and feasibility; data collection and completeness for physiological state and values for candidate primary outcomes (HbA1c and BMI). RESULTS A total of 82 participants (89% of those contacted and eligible) were randomized. All supported self-management sessions were completed by 35/41 participants (85%); only four completed no sessions. Data on the follow-up candidate primary outcomes HbA1c and BMI were obtained for 75/82 (91%) and 77/82 participants (94%), respectively. The mean baseline HbA1c was 56±16.5 mmol/mol (7.3±1.5%) and the mean BMI was 34±7.6 kg/m2 . CONCLUSIONS Adherence to supported self-management and willingness to have blood taken for outcome measurement was good. A definitive randomized controlled trial is feasible in this population. (Trial registration: Current Controlled Trials ISRCTN41897033).
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Affiliation(s)
- A. House
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - L. Bryant
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - A. M. Russell
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | | | - L. Graham
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | - R. Walwyn
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | - J. M. Wright
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - C. Hulme
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - J. L O'Dwyer
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - G. Latchford
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | | | - R. Ajjan
- Division of Cardiovascular and Diabetes ResearchUniversity of LeedsLeedsUK
| | - A. Farrin
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
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House A, Latchford G, Russell AM, Bryant L, Wright J, Graham E, Stansfield A, Ajjan R. Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability. Pilot Feasibility Stud 2018; 4:106. [PMID: 29862037 PMCID: PMC5975532 DOI: 10.1186/s40814-018-0291-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. METHODS In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention. RESULTS The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. CONCLUSIONS The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033 (registered 21/01/2013).
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amy M. Russell
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Elizabeth Graham
- Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Kelly L, Jenkinson C, Morley D. Experiences of Using Web-Based and Mobile Technologies to Support Self-Management of Type 2 Diabetes: Qualitative Study. JMIR Diabetes 2018; 3:e9. [PMID: 30291098 PMCID: PMC6238842 DOI: 10.2196/diabetes.9743] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of type 2 diabetes is rising, placing increasing strain on health care services. Web-based and mobile technologies can be an important source of information and support for people with type 2 diabetes and may prove beneficial with respect to reducing complications due to mismanagement. To date, little research has been performed to gain an insight into people’s perspectives of using such technologies in their daily management. Objective The purpose of this study was to understand the impact of using Web-based and mobile technologies to support the management of type 2 diabetes. Methods In-depth interviews were conducted with 15 people with type 2 diabetes to explore experiences of using Web-based and mobile technologies to manage their diabetes. Transcripts were analyzed using the framework method. Results Technology supported the users to maintain individualized and tailored goals when managing their health. A total of 7 themes were identified as important to participants when using technology to support self-management: (1) information, (2) understanding individual health and personal data, (3) reaching and sustaining goals, (4) minimizing disruption to daily life, (5) reassurance, (6) communicating with health care professionals, and (7) coordinated care. Conclusions Patients need to be supported to manage their condition to improve well-being and prevent diabetes-related complications from arising. Technologies enabled the users to get an in-depth sense of how their body reacted to both lifestyle and medication factors—something that was much more difficult with the use of traditional standardized information alone. It is intended that the results of this study will inform a new questionnaire designed to assess self-management in people using Web-based and mobile technology to manage their health.
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Affiliation(s)
- Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David Morley
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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New Possibilities in Life with Type 2 Diabetes: Experiences from Participating in a Guided Self-Determination Programme in General Practice. Nurs Res Pract 2018; 2018:6137628. [PMID: 29755787 PMCID: PMC5884023 DOI: 10.1155/2018/6137628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/04/2018] [Indexed: 01/18/2023] Open
Abstract
Research suggests that guided self-determination programmes can support self-management of diabetes by empowering self-determined goal setting and competence building. As most research in this area has focused on people with type 1 diabetes, knowledge is lacking on how adults with type 2 diabetes mellitus experience participation in such programmes. This study reports the modelling phase of a complex intervention design that explored the experiences of adults with type 2 diabetes who participated in a nurse-led guided self-determination programme in general practice and examines how the programme affected patients' motivation to self-manage diabetes. The qualitative design with semistructured interviews included 9 adults with type 2 diabetes who participated in the programme. Qualitative content analysis was used to analyse the data. The findings indicate that the participants experienced new life possibilities after participating in the programme, which seemed to have a positive influence on their motivation for self-management. Through reflections about how to live with diabetes, the participants reinterpreted their life with diabetes by gradually developing a closer relationship with the disease, moving towards acceptance. The fact that dialogue with the nurses was seen to be on an equal footing helped support the participants to become more self-determined.
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Wichit N, Mnatzaganian G, Courtney M, Schulz P, Johnson M. Psychometric testing of the Family-Carer Diabetes Management Self-Efficacy Scale. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:214-223. [PMID: 29108139 DOI: 10.1111/hsc.12511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to develop and test the construct and content validity, internal consistency of the Family-Carer Diabetes Management Self-Efficacy Scale (F-DMSES). A sample of 70 Thai individuals who cared for those living with type 2 diabetes mellitus (T2DM) in a rural community in Thailand was included in the study. Data were collected by a questionnaire survey in January 2014. The F-DMSES was initially derived from the DMSES, with subsequent forward and backward translations from and to English and Thai languages. The psychometric properties (content, construct and internal consistency) of the Thai version were explored using the Content Validity Index approach, exploratory factor analysis and Cronbach's alpha test. The F-DMSES initially designed with 20 items was reduced to 14 items within four factors (general diet and blood glucose monitoring, medications and complications, diet in differing situations, and weight control and physical activities), and explained 72.2% of the total variance in overarching construct. Internal consistency was supported (α = 0.89). The F-DMSES was also able to measure change over time following an intervention, with an effect size of 0.9. The F-DMSES is a valid and reliable self-administered instrument that measures the diabetes management self-efficacy of family-carers of individuals with T2DM. This instrument can be used in practice and clinical trials to assess the impact of family-carers on the health outcomes of individuals with T2DM.
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Affiliation(s)
- Nutchanath Wichit
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
- Faculty of Nursing, Suratthani Rajabhat University, Suratthani, Thailand
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, VIC, Australia
| | - Mary Courtney
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Paula Schulz
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
- Ingham Institution of Applied Medical Research Liverpool, Sydney, NSW, Australia
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Markle‐Reid M, Ploeg J, Fraser KD, Fisher KA, Bartholomew A, Griffith LE, Miklavcic J, Gafni A, Thabane L, Upshur R. Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity. J Am Geriatr Soc 2018; 66:263-273. [PMID: 29178317 PMCID: PMC5836873 DOI: 10.1111/jgs.15173] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. DESIGN Multisite, single-blind, parallel, pragmatic, randomized controlled trial. SETTING Four communities in Ontario, Canada. PARTICIPANTS Community-dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159). INTERVENTION Client-driven, customized self-management program with up to 3 in-home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation. MEASUREMENTS Quality-of-life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES-D-10), Summary of Diabetes Self-Care Activities (SDSCA), Self-Efficacy for Managing Chronic Disease, and healthcare costs. RESULTS Morbidity burden was high (average of eight comorbidities). Intention-to-treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference = 2.68, 95% confidence interval (CI) = 0.28-5.09, P = .03), SDSCA (mean difference = 3.79, 95% CI = 1.02-6.56, P = .01), and CES-D-10 (mean difference = -1.45, 95% CI = -0.13 to -2.76, P = .03). No group differences were seen in PCS score, anxiety, self-efficacy, or total healthcare costs. CONCLUSION Participation in a 6-month community-based intervention improved quality of life and self-management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs.
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Affiliation(s)
- Maureen Markle‐Reid
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Jenny Ploeg
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
- Department of Health, Aging and SocietyMcMaster UniversityHamiltonOntarioCanada
| | | | - Kathryn A. Fisher
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
| | - Amy Bartholomew
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - John Miklavcic
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Amiram Gafni
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonOntarioCanada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Ross Upshur
- Division of Clinical Public HealthDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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Psychoeducational interventions to improve adolescents’ medical management of diabetes: A comprehensive review. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.70357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zamani-Alavijeh F, Araban M, Mohammadi V, Goodarzi F. Development and psychometric evaluation of a new instrument to assess nutritional perceptions and behaviors of diabetic men. Diabetes Metab Syndr 2017; 11 Suppl 2:S949-S955. [PMID: 28709854 DOI: 10.1016/j.dsx.2017.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is obvious that unhealthy nutritional behaviors have caused the increasing incidence of diabetes. This study aimed to design the Measure of Nutritional Perceptions and Behaviors in diabetic men and to evaluate its psychometric properties. METHODS A questionnaire was developed within 7 factors. Three methods of face validity, content validity, and construct validity were employed to ensure the validity of the scale. 206 men with diabetes completed the questionnaires. Internal was used to evaluate the reliability of the scale. RESULTS The mean age of men was 58.26 (9.74) years. Results showed that each item in the final questionnaire was highly correlated with the total score of each dimension P<0.05. Moreover, factor analysis led to the extraction of 36 items with acceptable factor loadings in the range of 0.41 to 0.84, which could account for 51% of the total variance. The Cronbach's alpha coefficient equal to 0.83 was obtained for the whole scale. CONCLUSION The reliability and validity of diabetic men's beliefs about healthy nutritional behaviors were desired and the overall structure of the questions was confirmed. This questionnaire can be used to identify individuals at risk for unhealthy nutritional behaviors and also to conduct and evaluate the impact of educational interventions.
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Affiliation(s)
- Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Araban
- Social Determinants of Health Research Center, Dept. of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vida Mohammadi
- Department of Community Nutrition and Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fataneh Goodarzi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Adarmouch L, Elyacoubi A, Dahmash L, El Ansari N, Sebbani M, Amine M. Short-term effectiveness of a culturally tailored educational intervention on foot self-care among type 2 diabetes patients in Morocco. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 7:54-59. [PMID: 29067251 PMCID: PMC5651287 DOI: 10.1016/j.jcte.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/10/2017] [Accepted: 01/29/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-management education (SME) is an important yet unacknowledged aspect of diabetes care. Despite the raise of diabetes and its complications with significant burden in developing countries, research on SME interventions in Morocco is lacking. AIMS To assess the effectiveness of a culturally tailored SME intervention on foot-care self-management practices among type 2 diabetes patients and to identify factors associated with practices variation. METHODS We designed a pre-post prospective quasi-experimental study and recruited patients with type 2 diabetes aged 30 years old or above. The intervention consisted of an interactive group discussion using different materials: a narrative video, a PowerPoint presentation and a printed guide. Foot-care practices were assessed prior to the session and one month later using 2 items from the Summary of Diabetes Self-Care Activities (SDSCA). Binary logistic regression was performed to identify factors associated with a favorable variation, defined as an increase in the mean frequency score of foot-care by a minimum of 1 day/week. RESULTS A total of 199 participants were recruited and 133 completed the second assessment. Mean age was 55.2 ± 11.2 years old. Women represented 67% and 72% of participants was illiterate. The foot-care score mean increased from 3.5 ± 2.9 days to 5.9 ± 1.8 days one month after the intervention (mean variation was 2.4 ± 3.1 days; p < 0.001). A favorable variation was found among 75 (37.7%) participants. In multivariate analysis, literacy was associated with higher likelihood of a favorable variation of foot-care practices (OR = 2.82; 95%CI: 1.09-7.31) while previous education about diabetic foot was associated with lower likelihood of a favorable variation (OR = 0.26; 95%CI: 0.08-0.78). CONCLUSIONS There was a general improvement in foot-care practices after the intervention. Our findings suggest the role of literacy and previous patient education in shaping the observed variation. Culturally tailored interventions targeting other disease management domains are needed in our context.
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Affiliation(s)
- Latifa Adarmouch
- Clinical Research Unit, Mohammed VI University Hospital, Marrakech, Morocco.,Community Medicine and Public Health Department, PCIM Laboratory, School of Medicine, Cadi Ayyad University, Morocco
| | - Abdelhadi Elyacoubi
- Community Medicine and Public Health Department, PCIM Laboratory, School of Medicine, Cadi Ayyad University, Morocco
| | - Latifeh Dahmash
- Community Medicine and Public Health Department, PCIM Laboratory, School of Medicine, Cadi Ayyad University, Morocco
| | - Nawal El Ansari
- Department of Endocrinology and Diabetology, Mohammed VI University Hospital, Marrakech, Morocco
| | - Majda Sebbani
- Clinical Research Unit, Mohammed VI University Hospital, Marrakech, Morocco.,Community Medicine and Public Health Department, PCIM Laboratory, School of Medicine, Cadi Ayyad University, Morocco
| | - Mohamed Amine
- Clinical Research Unit, Mohammed VI University Hospital, Marrakech, Morocco.,Community Medicine and Public Health Department, PCIM Laboratory, School of Medicine, Cadi Ayyad University, Morocco
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Zeng Y, Liu X, Wang Y, Shen F, Liu S, Rastegar-Mojarad M, Wang L, Liu H. Recommending Education Materials for Diabetic Questions Using Information Retrieval Approaches. J Med Internet Res 2017; 19:e342. [PMID: 29038097 PMCID: PMC5662791 DOI: 10.2196/jmir.7754] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/06/2017] [Accepted: 08/29/2017] [Indexed: 01/28/2023] Open
Abstract
Background Self-management is crucial to diabetes care and providing expert-vetted content for answering patients’ questions is crucial in facilitating patient self-management. Objective The aim is to investigate the use of information retrieval techniques in recommending patient education materials for diabetic questions of patients. Methods We compared two retrieval algorithms, one based on Latent Dirichlet Allocation topic modeling (topic modeling-based model) and one based on semantic group (semantic group-based model), with the baseline retrieval models, vector space model (VSM), in recommending diabetic patient education materials to diabetic questions posted on the TuDiabetes forum. The evaluation was based on a gold standard dataset consisting of 50 randomly selected diabetic questions where the relevancy of diabetic education materials to the questions was manually assigned by two experts. The performance was assessed using precision of top-ranked documents. Results We retrieved 7510 diabetic questions on the forum and 144 diabetic patient educational materials from the patient education database at Mayo Clinic. The mapping rate of words in each corpus mapped to the Unified Medical Language System (UMLS) was significantly different (P<.001). The topic modeling-based model outperformed the other retrieval algorithms. For example, for the top-retrieved document, the precision of the topic modeling-based, semantic group-based, and VSM models was 67.0%, 62.8%, and 54.3%, respectively. Conclusions This study demonstrated that topic modeling can mitigate the vocabulary difference and it achieved the best performance in recommending education materials for answering patients’ questions. One direction for future work is to assess the generalizability of our findings and to extend our study to other disease areas, other patient education material resources, and online forums.
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Affiliation(s)
- Yuqun Zeng
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Traditional Chinese Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xusheng Liu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanshan Wang
- Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Feichen Shen
- Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sijia Liu
- Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Computer Science and Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Majid Rastegar-Mojarad
- Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Liwei Wang
- Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo College of Medicine, Mayo Clinic, Rochester, MN, United States
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Gijs E, Zuercher E, Henry V, Morin D, Bize R, Peytremann-Bridevaux I. Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument. J Eval Clin Pract 2017; 23:803-811. [PMID: 28251768 DOI: 10.1111/jep.12720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 12/07/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. METHODS Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. RESULTS Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. CONCLUSION Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.
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Affiliation(s)
- E Gijs
- Lausanne University Hospital, Lausanne, Switzerland
| | - E Zuercher
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - V Henry
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - D Morin
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Faculty of Nursing Science, Laval University, Quebec, Canada
| | - R Bize
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - I Peytremann-Bridevaux
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
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Lie SS, Karlsen B, Oord ER, Graue M, Oftedal B. Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study. J Med Internet Res 2017; 19:e187. [PMID: 28559223 PMCID: PMC5470008 DOI: 10.2196/jmir.7479] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 01/17/2023] Open
Abstract
Background Adequate self-management is the cornerstone of type 2 diabetes treatment, as people make the majority of daily treatment measures and health decisions. The increasing prevalence of type 2 diabetes mellitus (T2DM) and the complexity of diabetes self-management demonstrate the need for innovative and effective ways to deliver self-management support. eHealth interventions are promoted worldwide and hold a great potential in future health care for people with chronic diseases such as T2DM. However, many eHealth interventions face high dropout rates. This led to our interest in the experiences of participants who dropped out of an eHealth intervention for adults with T2DM, based on the Guided Self-Determination (GSD) counseling method. Objective In this study, we aimed to explore experiences with an eHealth intervention based on GSD in general practice from the perspective of those who dropped out and to understand their reasons for dropping out. To the best of our knowledge, no previous qualitative study has focused on participants who withdrew from an eHealth self-management support intervention for adults with T2DM. Methods A qualitative design based on telephone interviews was used to collect data. The sample comprised 12 adults with type 2 diabetes who dropped out of an eHealth intervention. Data were collected in 2016 and subjected to qualitative content analysis. Results We identified one overall theme: “Losing motivation for intervention participation.” This theme was illustrated by four categories related to the participants’ experiences of the eHealth intervention: (1) frustrating technology, (2) perceiving the content as irrelevant and incomprehensible, (3) choosing other activities and perspectives, and (4) lacking face-to-face encounters. Conclusions Our findings indicate that the eHealth intervention based on GSD without face-to-face encounters with nurses reduced participants’ motivation for engagement in the intervention. To maintain motivation, our study points to the importance of combining eHealth with regular face-to-face consultations. Our study also shows that the perceived benefit of the GSD eHealth intervention intertwined with choosing to focus on other matters in complex daily lives are critical aspects in motivation for such interventions. This indicates the importance of giving potential participants tailored information about the aim, the content, and the effort needed to remain engaged in complex interventions so that eligible participants are recruited. Finally, motivation for engagement in the eHealth intervention was influenced by the technology used in this study. It seems important to facilitate more user-friendly but high-security eHealth technology. Our findings have implications for improving the eHealth intervention and to inform researchers and health care providers who are organizing eHealth interventions focusing on self-management support in order to reduce dropout rates.
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Affiliation(s)
| | - Bjørg Karlsen
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Marit Graue
- Centre for Evidence-based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bjørg Oftedal
- Department of Health Studies, University of Stavanger, Stavanger, Norway
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Wu CJJ, Sung HC, Chang AM, Atherton J, Kostner K, McPhail SM. Cardiac-diabetes self-management program for Australians and Taiwanese: A randomized blocked design study. Nurs Health Sci 2017; 19:307-315. [PMID: 28544230 DOI: 10.1111/nhs.12346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/06/2017] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
Cardiac disease and type 2 diabetes are prevalent diseases globally. Cardiac rehabilitation and diabetes self-management programs empower patients' self-management to improve their health outcomes. However, inappropriate delivery modes and continuing low participation rates indicate some programs are less than optimal. A previous study demonstrated the feasibility of incorporating telephone and text messages into a cardiac-diabetes self-management program in Australia; however, the program did not specifically address patients' cultural backgrounds. This current study used a randomized blocked design to evaluate short-term efficacy of the cardiac-diabetes self-management program incorporating telephone and text-messaging across different cultural contexts in Australia and Taiwan in comparison to usual care. No significant differences between groups were observed for outcomes of self-care behavior, self efficacy, knowledge and health-related quality of life, with patients in both groups demonstrating improvements. Patient-reported outcomes indicated some evidence of an interaction effect between country of origin and group allocation. Findings indicated an improved tendency of outcome measures between the baseline and follow-up assessments within usual care and intervention groups. Further research is required to clarify components of the program work for each cultural group.
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Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Queensland, Australia
| | - Huei-Chuan Sung
- Graduate Institute of Long-term Care and Taiwanese Center of Evidence-based Health Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Anne M Chang
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - John Atherton
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karam Kostner
- Mater Adult Hospital, Mater Health Services, South Brisbane, Queensland, Australia
| | - Steven M McPhail
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
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Crawford J, Wilhelm K, Robins L, Proudfoot J. Writing for Health: Rationale and Protocol for a Randomized Controlled Trial of Internet-Based Benefit-Finding Writing for Adults With Type 1 or Type 2 Diabetes. JMIR Res Protoc 2017; 6:e42. [PMID: 28292741 PMCID: PMC5373675 DOI: 10.2196/resprot.7151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Diabetes mellitus is Australia’s fastest growing chronic disease, and has high comorbidity with depression. Both subthreshold depression and diabetes distress are common amongst people with type 1 or type 2 diabetes, and are associated with poorer diabetes self-care. A need exists for low-intensity self-help interventions for large numbers of people with diabetes and diabetes distress or subthreshold depression, as part of a stepped-care approach to meeting the psychological needs of people with diabetes. Benefit-finding writing is a very brief intervention that involves writing about any positive thoughts and feelings about a stressful experience, such as an illness. Benefit-finding writing has been associated with increases in positive affect and positive growth, and has demonstrated promising results in trials amongst other clinical populations. However, benefit-finding writing has not yet been examined in people with diabetes. Objective The aim of this randomized controlled trial (RCT) is to evaluate the efficacy of an Internet-based benefit-finding writing (iBFW) intervention for adults with type 1 or type 2 diabetes (compared to a control writing condition) for reducing diabetes distress and increasing benefit-finding in diabetes, and also improving a range of secondary outcomes. Methods A two-arm RCT will be conducted, using the online program Writing for Health. Adults with type 1 or type 2 diabetes living in Australia will be recruited using diabetes-related publications and websites, and through advertisements in diabetes services and general practitioners’ offices. Potential participants will be referred to the study-specific website for participant information and screening. All data will be collected online. Participants will be randomized to either iBFW about diabetes, or a control writing condition of writing about use-of-time. Both conditions involve three daily sessions (once per day for three consecutive days) of 15-minute online writing exercises. Outcome measures will be administered online at baseline, one-month, and three-month follow-ups. Results This trial is currently underway. The primary outcomes will be diabetes distress and benefit-finding in diabetes. Secondary outcomes will be depression, anxiety, diabetes self-care, perceived health, and health care utilization. We aim to recruit 104 participants. All stages of the study will be conducted online using the Writing for Health program. Group differences will be analyzed on an intention-to-treat basis using mixed models repeated measures. Linguistic analyses of the writing exercise scripts, and examinations of the immediate emotional responses to the writing exercises, will also be undertaken. Conclusions This RCT will be the first study to examine iBFW for adults with type 1 or type 2 diabetes. If iBFW is found to be efficacious in reducing diabetes distress and improving diabetes self-care and other outcomes, iBFW may offer the potential to be a low-cost, easily accessible self-help intervention to improve the wellbeing of adults with diabetes. Trial Registration Australia and New Zealand Clinical Trials Registry (ACTRN12615000241538)
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Affiliation(s)
- Joanna Crawford
- Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kay Wilhelm
- Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Consultation Liaison Psychiatry, St. Vincent's Health Australia, Sydney, Australia
| | - Lisa Robins
- Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.,Consultation Liaison Psychiatry, St. Vincent's Health Australia, Sydney, Australia
| | - Judy Proudfoot
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia
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Zimbudzi E, Lo C, Ranasinha S, Kerr PG, Usherwood T, Cass A, Fulcher GR, Zoungas S. Self-management in patients with diabetes and chronic kidney disease is associated with incremental benefit in HRQOL. J Diabetes Complications 2017; 31:427-432. [PMID: 27914731 DOI: 10.1016/j.jdiacomp.2016.10.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/03/2016] [Accepted: 10/26/2016] [Indexed: 02/04/2023]
Abstract
AIMS There is insufficient and inconsistent data regarding the association between diabetes self-management, the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care, and health-related quality of life (HRQOL) in people with diabetes and moderate to severe chronic kidney disease (CKD). METHODS In a cross sectional study, participation in diabetes self-management assessed by the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and HRQOL was examined in 308 patients with diabetes and CKD (stages 3 to 5) recruited from outpatient diabetes and renal clinics of 4 public tertiary hospitals. Associations were examined by Pearson correlation coefficients and hierarchical multiple regression after controlling for potential confounders. An examination of trend across the levels of patient participation in self-management was assessed using a non-parametric test for trend. RESULTS The median age and interquartile range (IQR) of patients were 68 and 14.8years, respectively with 59% of the population being over 65years old and 69.5% male. The median durations of diabetes and CKD were 18years (IQR-17) and 5years (IQR-8) respectively. General diet, exercise and medication taking were positively associated with at least one HRQOL subscale (all p<0.05) but diabetes specific diet, blood sugar testing and foot checking were not. As levels of participation in self-management activities increased there was a graded increase in mean HRQOL scores across all subscales (p for trend <0.05). CONCLUSIONS In people with diabetes and moderate to severe CKD, participation in diabetes self-management activities, particularly those focused on general diet, exercise and medication taking, was associated with higher HRQOL.
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Affiliation(s)
- Edward Zimbudzi
- Department of Nephrology, Monash Health, Melbourne, Australia; Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Clement Lo
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Timothy Usherwood
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of General Practice, Sydney Medical School Westmead, Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Darwin, Australia
| | - Gregory R Fulcher
- Department of Endocrinology, University of Sydney, Sydney, Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia; The George Institute for Global Health, University of Sydney, Sydney, Australia.
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